Prevalence of healthcare workers fully vaccinated against hepatitis B without circulating antibodies in Italy and role of age at baseline cycle vaccination: a systematic review and meta-analysis

ABSTRACT

Introduction

Healthcare workers (HCWs) susceptible to hepatitis B represent an important public health concern. National and international guidelines recommend assessing the hepatitis B immune status of all HCWs and possibly vaccinating those found to be seronegative (non-responders). We conducted a meta-analysis to estimate the rate of hepatitis B sero-susceptibility among HCWs in Italy and to explore possible options for the management of non-responders.

Areas Covered

Nineteen studies, selected from scientific articles available in the Scopus, MEDLINE/PubMed and ISI Web of Knowledge databases between 1 January 2016 and 22 April 2022, were included. The prevalence of HBV-susceptible HCWs was 27.1% (95%CI = 23.2–31.7%). In a comparison by sex (males vs. females) the RR was 1.16 (95%CI = 1.03–1.31), and by full-cycle vaccination period (adolescence vs. infancy) the RR was 0.30 (95%CI = 0.25–0.37). Occupational health screenings for hepatitis B, with subsequent vaccination of non-responders, and exclusion of susceptible HCWs from high-risk settings have been common management strategies.

Expert opinion

It is highly probable that a proportion of the next generation of medical students and HCWs will not show circulating IgG on serologic evaluation. Therefore, more targeted efforts are needed to identify these individuals and actively immunize them.

KEYWORDS:

• Healthcare workers
• management of susceptible
• HBV
• nosocomial infection
• non-responder

Article highlights

• Good evidence of significant susceptibility to hepatitis B among HCWs is reported in the scientific literature

• Italy was the first industrialized country to adopt a universal vaccination strategy against hepatitis B

• Our meta-analysis estimated a hepatitis B susceptibility rate among fully vaccinated HCWs in Italy of 27%

• more than 91% (95%CI=89-93%) of subjects responded to the booster dose

• Unimmunized and unresponsive HCWs are a real public health concern

• Future HCWs vaccinated at a young age will probably not show circulating antibodies

• A booster dose administered periodically or promotion of the screening described above seems necessary

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or mending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

FPB and ST conceived the study. FPB and AM did the literature research. FPB did the metanalysis. GM and PS participated in the design of the metanalysis. CAG and LV supervisioned the metanalysis. FPB and ST codrafted the first version of the article.

Additional information

Funding

The study was founded by Apulia’s Regional Observatory for Epidemiology.